desinfection faq

7/30/2019 desinfection faq

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USAF Dental Evaluation & Consultation Service

1Distribution Statement A: Approved for public release; distribution is unlimited. 88ABW-2011-5681, 24 Oct 2011.

Return to Infection Control Questions Disinfection

Avoiding Cross Contamination of Dental Supplies Tuberculocidal Claim Cleaning & Disinfecting Toys in the Dental Clinic

MTF List of Approved Disinfectants Washing Utility Gloves Computer Equipment in the Dental Operatory Disinfecting with Liquids or WipesCleaning Dental Anesthetic Cartridges Before Surgical Procedures The Importance of Chemical Disinfectants in Infection Control 70.5% Ethyl Alcohol Solutions as Surface Disinfectants Factors to Consider in Selecting a Surface Disinfectant The Best Way to Disinfect a Dental Chair Regulating Chemical Germicides The Proper Way to Disinfect an Environmental Surface Detergent Options for the Miele G7781 Dental Thermal Disinfector

Avoiding Cross Contamination of Dental Supplies (11/11)

Question: Do you have any suggestions for avoiding crosscontamination of dental supplies?

Answer: Because many dental materials are packaged in multidosecontainers, bottles, or tubes, dental health-care personnel (DHCP)need to avoid cross-contaminating these supplies when handlingthem during patient treatment. It is preferable to unit dose materialsand supplies, that is dispense small amounts sufficient for care of one patient before treatment begins. Whatever is not used with thepatient is discarded. Dental manufacturers are aware of the potentialfor cross contamination and many companies now offer unit-dose packages of their product. Whenever

possible, apply unit-dose practices because this limits

contamination and time-consuming cleaning and disinfectionprocedures. If unit-dosing techniques are not used, the itemshould be covered with a barrier to avoid contamination. If abarrier is not used, the item must be cleaned and disinfectedbetween patients if it becomes contaminated.

Whenever retrieving an item for patient-care during treatment,aseptic technique must be practiced. DHCP should use a

sterile instrument (e.g., cotton pliers, forceps) when retrievingan item for use to avoid contamination of unused items in the container or drawer.

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Tuberculocidal Claim (10/11) Question: Since tuberculosis (TB) isn’t transmitted via contaminatedenvironmental surfaces, why is it important for a disinfectant to betuberculocidal?

Answer: Many times there is confusion regarding the claim for tuberculocidalactivity for disinfectants. You are correct that TB is not transmitted viaenvironmental surfaces but rather by the airborne route. Potency againstMycobacterium tuberculosis has been recognized as a substantial benchmark to

http://airforcemedicine.afms.mil/idc/groups/public/documents/webcontent/knowledgejunction.hcst?functionalarea=DentalEvalConsultation&doctype=subpage&docname=CTB_109859

http://airforcemedicine.afms.mil/idc/groups/public/documents/webcontent/knowledgejunction.hcst?functionalarea=DentalEvalConsultation&doctype=subpage&docname=CTB_109859





measure germicidal potency. Accordingly, use of such products on environmental surfaces plays no rolein preventing the spread of tuberculosis. However, because mycobacteria have among the highestintrinsic levels of resistance among the vegetative bacteria, viruses, and fungi, any germicide with atuberculocidal claim on the label is considered capable of inactivating a broad spectrum of pathogens,including such less-resistant organisms as bloodborne pathogens (e.g., hepatitis B virus, hepatitis Cvirus, and HIV). It is this broad-spectrum capability, rather than the product’s specific potency againstmycobacteria, that is the basis for protocols and regulations dictating use of tuberculocidal chemicals for environmental surface disinfection.

ReferenceCDC. Guidelines for infection control in dental health-care settings - 2003. MMWR 2003; 52(No. RR-17).

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Cleaning & Disinfecting Toys in the Dental Clinic (8/10)

Question: Are children’s toys allowed in our dental clinic waiting rooms? If they areallowed, are we required to clean and disinfect them?

Answer: Because shared toys may become a means of transmitting respiratory viruses or pathogenic bacteria, the Centers for Disease Control and Prevention (CDC) offers

infection control guidance to facilities that have waiting areas with children’s toys. TheCDC recommends establishing policies and procedures for cleaning toys at regular intervals. The CDC provides the following guidance which may be helpful as youdevelop policy in your facility.

Select play toys that can be easily cleaned and disinfected. Do not permit use of stuffed furry toys if they will be shared. Clean and disinfect large stationary toys (e.g., climbing equipment) at least weekly and whenever visibly soiled. If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher.When a toy requires cleaning and disinfection, do so immediately or store in a designated labeledcontainer separate from toys that are clean and ready for use.

Reference Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices AdvisoryCommittee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcaresettings, 2007: 82. Available at www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html. AccessedSeptember 2010.

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MTF List of Approved Disinfectants (7/09)

Question: We want to switch to a new disinfectant; however I cannot locate themedical treatment facility (MTF) list of approved products to check if the product is

acceptable. Do you know where I could find the list? I’ve also heard that if theproduct is not on the approved product list, we can’t use it; is this true?

Answer: The MTF list of approved disinfectants is usually located in the MTFInfection Control Instruction or as an attachment to the Infection Control Annual Plan.If the product you’ve chosen is not on the list it does not mean it is not acceptable for use. You’ll have to obtain approval though your local infection controlcommittee/review function before purchase and use. If this is necessary, I would recommend having asmuch of the product information available as possible when you present your request. Keep in mind thatminimal requirements for disinfectants used in USAF dental facilities include that the product must be:

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html





- registered with the Environmental Protection Agency (EPA),- hospital-grade (i.e., kills three specific organisms: Staphylococcus aureus , Salmonella enterica [formerly Salmonella choleraesuis ], Pseudomonas aeruginosa ), and- intermediate-level (i.e., have tuberculocidal activity).

When meeting with the MTF infection control officer or committee to discuss your request it may behelpful to have the following information available: EPA-registration number, a list of active ingredients,recommended contact times, directions for use, storage and disposal information, and any other safetyinformation (most manufacturers provide the product MSDS on their Web site).

References- Air Force Instruction 44-108, Infection Control Program.- USAF Guidelines for Infection Control in Dentistry.

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Washing Utility Gloves (10/08)

Question: Can I wash my utility gloves?

Answer: Unlike gloves used during patient-care activities, utility gloves are not regulatedby the Food and Drug Administration (FDA) and can be washed or disinfected for reuse.Utility gloves should be routinely inspected and replaced if tears, cracks or other signs of deterioration occur.

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Computer Equipment in the Dental Operatory (8/05)

Question: Are there special considerations for cleaning and disinfecting computer equipment in thedental operatory? Does DECS know of any computer equipment that is waterproof?

Answer: Computers present unique infection-control challenges.Studies have shown that computer equipment can serve as a potentialreservoir for infectious agents. A computer keyboard and the mouse are

excellent examples of difficult, if notimpossible, items to clean. The bestresults with the least damage to theequipment are obtained by followingmanufacturer's directions, however most computer companies onlyprovide basic cleaning instructions for their computer hardware and do notoffer instructions for disinfection in health-care settings. Avoiding

contamination is important because many items cannot be properly cleaned and disinfected or sterilized.Good hand-hygiene is important. Before touching any office equipment, ensure your hands are clean, andif wearing gloves select a powder-free brand. The basic principles of cleaning and disinfection usedroutinely in the dental operatory also apply to computer equipment. Therefore computer equipment thatcan tolerate the use of liquid disinfectant products may be preferable and easier to maintain. If thecleaning and disinfecting products used in the dental clinic are not compatible with the computer equipment, the computer equipment should be covered with a plastic barrier when contamination is likely.Like any barrier used during patient care, it should be changed between patients. If a reusable form-fittedbarrier is used, it should be cleaned and disinfected between patients. Listed below is a brief list of infection-control related items for computer equipment and the companies that manufacture or sell them.





Keyboard CoversProduct Company Contact InformationFlexshield Keyboard ProtectionSkins

Hooleon (800) 937-1337 www.hooleon.com/index.htm

Large QUIKcaps Practicon Dental (800) 959-9505www.practicon.com

Seal’nType Kador Ltd. (800) 878-6720www.kador.com/comp.htm Viziflex Keyboard Seels Viziflex (800) 627-7752

www.viziflex.com

Liquidproof/Waterproof KeyboardProduct Company Contact InformationSlimKey MD IKEY (800) 866-6506

www.ikey.com Washable Keyboards Unotron (877) 861-1130

www.ruggedtech.com/unotron.html

Water Resistant Keyboards Man & Machine Medical Products (301) 341-4900www.man-machine.com

Flexible Dental Keyboard and

Mouse™

Hayes Handpiece – Greater Long

Island Repair Center

(516) 650-1443

http://www.hayesgli.com.Liquidproof/Waterproof MouseProduct Company Contact Information

AquaPoint™ Optical Mouse. IKEY (800) 866-6506www.ikey.com

Mighty Mouse Man & Machine MedicalProducts

(301) 341-4900www.man-machine.com

Note: The listing or omission of a product does not imply endorsement, approval, or disapproval by DECS.

Selected References 1. Hartmann B, Benson M, Junger A, Quinzio L, Rohrig R, Fengler B, et al. Computer keyboard andmouse as reservoir of pathogens in an intensive care unit. J Clin Monit Comput 2004;18:7–12.

2. Hassoun A, Vellozzi EM, Smith MA. Colonization of personal digital assistants carried by health careprofessionals. Infect Control Hosp Epidemiol 2004;25:1000–1001.3. Ivey JC, Oomen B, Forstall G. Fungal contamination related to personal computer devices installed in ahospital intensive care unit. Am Soc Microbiol Abstrs 2001;L1:469.4. Man GS, Olapoju M, Chadwick MV, Vuddamalay P, Hall AV, Edwards A, et al. Bacterial contaminationof ward-based computer terminals. J Hosp Infect 2002;52:314–315.5. Neely AN, Maley MP, Warden GD. Computer keyboards as reservoirs for Acinetobacter baumannii in aburn hospital. Clin Infect Dis 1999;29:1358–1360.6. Neely AN, Weber JM, Daviau P, MacGregor A, Miranda C, Nell M, Bush P, Lighter D. Computer equipment used in patient care within a multihospital system: Recommendations for cleaning anddisinfection. Am J Infect Control 2005;33:233–237.7. Schultz M, Gill J, Zubairi S, Huber R, Gordin F. Bacterial contamination of computer keyboards in ateaching hospital. Infect Control Hosp Epidemiol 2003;24:302–303.

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Disinfecting with Liquids or Wipes (4/05) UPDATED (4/11)

Question: Our clinic is considering switching over to disinfectant wipes to decrease the amount of chemicals sprayed into the air. Is this a good idea, and if so, how do we go about choosing one?

Answer: “Overspraying” chemical disinfectants in the dental operatory can compromise the integrity of equipment, discolor surfaces, and has reportedly caused clinical symptoms such as respiratory problems,allergies, eye and skin irritation, and headaches. Using pump dispensers vs. aerosol sprays can decreasethe amount of chemicals sprayed in the environment. Also, holding a paper towel behind the surface,

http://www.hooleon.com/index.htm

http://www.kador.com/comp.htm

http://www.ikey.com/

http://www.ruggedtech.com/unotron.html

http://www.hayesgli.com/


http://www.hooleon.com/index.htm

http://www.practicon.com/

http://www.kador.com/comp.htm

http://www.viziflex.com/


http://www.ruggedtech.com/unotron.html

http://www.man-machine.com/

http://www.hayesgli.com/


http://www.man-machine.com/





when spraying the disinfectant, can reduce the excess spray. If used correctly,disposable cloth or paper disinfectant wipes are an effective choice for environmental asepsis in health-care settings and because cloth or paper disinfectant wipes are presaturated with chemical cleaners and antimicrobialagents they decrease the amount of chemicals sprayed in the environment.Most of the currently available disinfectant wipes contain a range of isopropanolconcentrations in addition to other chemical agents which function primarily assurface cleaners. Just as when using a liquid disinfectant, the surface must becleaned first and then disinfected. Therefore, to be effective it’s necessary to usetwo cloths—one for cleaning and another for disinfecting the surface. While these disinfectant cloths maybe a more convenient alternative to spraying chemicals to clean and disinfect surfaces, the user isultimately responsible for ensuring that the product is used correctly and meets all of therequirements of a traditional liquid spray disinfectant. In USAF dental clinics, use environmentalsurface disinfectants that are:- registered with the Environmental Protection Agency (EPA),- hospital-grade (i.e., kills three specific organisms: Staphylococcus aureus , Salmonella enterica [formerlySalmonella choleraesuis ], Pseudomonas aeruginosa ), and- intermediate-level (i.e., have tuberculocidal activity).

SELECT INTERMEDIATE-LEVEL (TUBERCULOCIDAL) SURFACE DISINFECTANT WIPES1

Always follow manufacturer instructions regarding use, specifically contact time. Contact times vary withdifferent brands and for different microbes; it is recommended to use the longest contact time on thelabel for disinfection.Note: The contact times are current as of 4/2011; users should refer to the product label for the mostcurrent instructions. Contact times are listed for comparison purposes and are subject to change.

ProductCategory

Examples of ActiveIngredients

Product ExampleBrand name(Company)

TuberculocidalContact Time

(minutes)

LongestRecommendedContact Time

(minutes)

ContactInformation

Chlorines Sodium hypochlorite,diluted in-officechlorine dioxide,

commercialpreparations of sodium hypochloritewith addedsurfactants

Chlorox GermicidalWipes (BosworthCompany)

2 5 www.bosworth.com (800) 323-4352

DISPATCH® Hospital

Cleaner DisinfectantTowels with Bleach(Caltech Ind.)

2 2 www.caltechind.com

(800) 234-7700

Phenolics Alcohol- or water-based and multiplephenolic compounds

ProSpray™ Wipes(Certol International,LLC)

10 10 www.certol.com (800) 843-3343

Alcohol-BasedQuaternaryAmmoniumCompounds

2

Alcohol and multiplequaternaryammoniumcompounds

CaviWipes® (Metrex) 3 3 www.metrex.com (800) 841-1428

Sani-Cloth® PlusGermicidal DisposableCloth (ProfessionalDisposables, Inc.)

5 5 www.pdipdi.com (800) 999-6423

Super Sani-Cloth®

Germicidal DisposableWipe (ProfessionalDisposables, Inc.)

1 2 www.pdipdi.com

(800) 999-6423

Sanitex Plus Wipes™(Crosstex International)

5 5 www.crosstex.com (800) 223-2497

The listing or omission of a product in this table does not imply endorsement, approval, or disapproval by DECS. The productexamples listed are not intended to be all-inclusive or represent recommendations by the USAF.1 Disposable wipe/cloth presaturated with disinfectant2 All alcohol-free quaternary ammonium compounds (quats) are categorized as low-level disinfectants and do nothave tuberculocidal activity.

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http://www.bosworth.com/

http://www.caltechind.com/

http://www.bosworth.com/

http://www.caltechind.com/

http://www.certol.com/

http://www.metrex.com/

http://www.pdipdi.com/

http://www.pdipdi.com/

http://www.crosstex.com/





Cleaning Dental Anesthetic Cartridges Before Surgical Procedures (5/04)

Question: Can local anesthetic cartridges be heat sterilized before use during a surgical procedure?

Answer: The contents of a local anesthetic cartridge are sterile; the exterior surface of thecartridge is not. Therefore, anesthetic cartridges should be stored in a manner thatprevents cross contamination and handled aseptically before any dental procedure.

Although one study indicated that heat sterilizing the cartridges did not affect the cartridgecontents,

1manufacturers do not recommend heat sterilizing anesthetic cartridges because

the high temperatures can affect the cartridge contents (e.g., breakdown of thevasoconstrictor) and can cause cartridge failure (e.g., extruded plunger). While it is notrecommended to soak the cartridges in a disinfectant solution prior to use, most manufacturers agree thatit is acceptable to use an alcohol wipe to clean the anesthetic cartridge prior to placing the cartridge onthe surgical tray. If contamination is suspected, the cartridge should be discarded immediately.

References1. Kelly JR, Dalm GW. Stability of epinephrine in dental anesthetic solutions: implications for autoclavesterilization and elevated temperature storage. Mil Med 1985;150:112–114.

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The Importance of Chemical Disinfectants in Infection Control (Updated September 2004)

Question: What role do chemical disinfectants play in an infection control program? Should we brief thestaff about disinfectants? What features are important?

Answer: Chemical disinfectants are an essential part of an infection control program. When usedproperly, disinfectants can help control the environment and make the dental clinic a much safer place for patients and dental health-care personnel (DHCP).In many clinics, very little emphasis is placed on the proper selection and application of chemicaldisinfectants. It is important to establish a system that aids workers in using chemicals wisely. The goalshould be to ensure all staff members understand the types of chemicals used and how to properly usethem.

It is important to stress the difference between cleaners that remove soil but do not kill microbes, anddisinfectants, which are designed to kill some microorganisms. Many clinics choose agents that are bothcleaners and disinfectants. This saves resources and time. Dental clinics must make the correct choicewhen selecting chemical disinfectants.

Employees should understand that not all disinfectants are of equal strength. Disinfectants are generallygrouped into three categories: low level, intermediate level, and high level. Dental clinics need to selectthe appropriate strength disinfectant for the job. Low- and intermediate- level disinfectants are used todisinfect environmental surfaces. High-level disinfectants are used to disinfect heat-sensitive semicriticalitems.

At each of these levels there are several different chemical types from which to choose. Factorsinfluencing selection include application, item compatibility, and contact time. Every worker should beprovided with basic information about the types of chemical disinfectants used in their clinic. Trainingshould include information about the strength and limits of each disinfectant and its proper use.

Chemical compatibility with the item to be disinfected is a major consideration in selection. It is importantto remember that some disinfectants can have a very detrimental effect on specific materials, resulting inimmediate damage or long-term effects that can shorten the life of an item.

Proper disinfection begins with selecting the right product, but it must also be applied correctly. Often,failures encountered with disinfectants are related to human error. To avoid problems, read the labelfirst and then follow the instructions exactly. The label will provide information about the product’sability to kill specific microbes and give guidelines for proper application.





Failure to follow these instructions may result in failure to achieve the desired results. Also, disinfectantsmust be used in the right concentration for efficacy, meaning they must be measured exactly. It theconcentrate is too diluted, it may not be adequate to do the job. Another problem with improper measurement is using too much. Solutions that are too strong will tend to be less effective as well. Usingmore chemicals than are needed also results in increased exposure to personnel and increased operatingcosts for the clinic.

Along with selecting the proper disinfectant and mixing it correctly, all staff members should ensure thatitems to be disinfected have been properly prepared. Disinfectants must come in direct contact with allsurfaces to work completely. Once a disinfectant has been applied correctly, it must remain in contact for the labeled contact time. Again, remember that successful use depends on the user. The chemicals willonly do what the label claims and are unable to compensate for human error. Success is based onproper preparation, precise dilution, correct application, and adequate exposure time.

Misuse of disinfectants leads to a false sense of security. Improperly-processed items may look clean andsafe which lull the user into thinking all is well. When this happens, the risk of cross-contamination isincreased, and unsuspecting DHCP or patients may come into contact with these items. Inadequatedisinfection processes lead to failure of the clinic infection control system. Prevention requires that allpersonnel understand their role in chemical disinfection.

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70.5% Ethyl Alcohol Solutions as Surface Disinfectants (Originally published in the May 2001 issueof InCONTROL)

Question: Our clinic is contemplating purchasing a new surface disinfectant because it is cheaper thanwhat we are presently using. The product we want to buy is a 70.5% ethyl alcohol solution. Would yourecommend our clinic purchase this product?

Answer: No, alcohols generally do not make suitable surface disinfectants because they are ineffective inthe presence of tissue proteins such as those found in blood and saliva. Also, alcohols are poor cleanersand evaporate rapidly, decreasing disinfection activity.

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Factors to Consider in Selecting a Surface Disinfectant (7/08)(Originally published in the Jan 2001 issue of InControl)

Question: Our clinic is considering purchasing a new environmentalsurface disinfectant for our dental operatories. What criteria should we usefor selection?

Answer: The choice of specific cleaning or disinfecting agents is largely amatter of judgment, guided by product label claims and instructions andgovernment regulations. A single product might not satisfy all disinfectionrequirements in a given dental facility. Use of disinfectant products dependson consideration of multiple factors, including the degree of microbial killingrequired; the nature and composition of the surface, item, or device to betreated; and the cost, safety, and ease of use of the available agents.

In USAF dental clinics, environmental surface disinfectants must be1. registered with the Environmental Protection Agency (EPA),2. hospital-grade (i.e., kills three specific organisms: Staphylococcus aureus , Salmonella enterica [formerly Salmonella choleraesuis ], Pseudomonas aeruginosa ), and3. intermediate-level (i.e., have tuberculocidal activity).

Many times there is confusion regarding the claim for tuberculocidal activity. Many people wonder why itis important for a disinfectant to be tuberculocidal. The reason is that Mycobacterium tuberculosis is themost difficult microorganism to destroy (next to spore-producing microbes) because of its waxy outer cell





wall. If you can kill M. tuberculosis in a certain amount of time, you have also destroyed HIV, HepatitisB/C and all other microorganisms, except spore-producers. As a reminder, the tuberculocidal claim isused only as a benchmark to measure germicidal potency. Tuberculosis is not transmitted viaenvironmental surfaces but rather by the airborne route. Accordingly, use of such products onenvironmental surfaces plays no role in preventing the spread of tuberculosis.

Chemical compatibility with the item to be disinfected is a major consideration in selection. It is important

to remember that some disinfectants can have a very detrimental effect on specific materials, resulting inimmediate damage or long-term effects that can shorten the life of an item. Dental device and equipmentmanufacturers should provide information regarding material compatibility with liquid chemical germicides,whether equipment can be safely immersed for cleaning, and how it should be decontaminated if servicing is required.

Disposal issues should also be considered. In some locations, there may be restrictions on the use of phenolic or chlorine-based disinfectants. It is also important to consider shelf life (i.e., how long thedisinfectant is effective in the unopened container) and use-life (i.e., how long it is effective after openingor mixing) when evaluating the cost-effectiveness of the disinfectant. Issues regarding disposal are morelikely to be a problem if significant quantities of the solution must be routinely disposed of due toexpiration dating.

Also, don’t forget to check the Medical Treatment Facility (MTF) list of approved disinfectants (usually

located in the MTF Infection Control Instruction or as an attachment to the Infection Control Annual Plan).If the product you’ve chosen is not on the list, you’ll have to obtain approval though the local infectioncontrol committee/review function before purchase and use.

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The Best Way to Disinfect a Dental Chair (Originally published in the Jan 2001 issue of InCONTROL)

Question: What are the recommendations for disinfecting dental chairs?

Answer: My first choice would be to barrier protect the chair. If that is not possible, I would follow thechair manufacturer's recommendations for disinfection. After the proper contact time with the disinfectant,I would recommend rinsing and drying the chair. This should help reduce staining and cracking of theupholstery. The chair (except perhaps for control buttons and the headrest) is not considered a high riskfor cross contamination and does not require disinfection between patients unless visibly soiled.

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Regulating Chemical Germicides (Updated September 2004)

Question: Who is responsible for regulating chemical germicides?

Answer: The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA)share the regulatory responsibility. Recently the FDA and EPA signed a memorandum of understandingto clarify each organization's authority. General-purpose disinfectants (low/intermediate level) will beregulated by the EPA and will eventually be exempt from 510 (k) requirements. The FDA will regulatehigh-level disinfectants and chemical sterilants.

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The Proper Way to Disinfect an Environmental Surface (Originally published in the May 2002 issueof InCONTROL)

Question: What is the proper way to disinfect an environmental surface?

Answer: Disinfection consists of three steps.

1. Donning utility gloves, mask, protective eyewear, and protective clothing to guard against chemicalexposure during cleaning and disinfection.

2. Cleaning the surfaces with a cleaning agent by vigorously wiping the contaminated surfaces with paper towels.

3. Disinfecting the precleaned surface by applying the disinfectant over the entire precleaned surface. Allow the surface to remain moist for the contact time recommended by the manufacturer. If the surface isstill wet when patient treatment is to begin, wipe the surface dry with clean towels. If the surface willcontact the patient's skin, rinse the residual disinfectant with water.

Most infection control experts agree that using a single product that is formulated to both clean anddisinfect environmental surfaces can improve clinic turn-around time and reduce cost.

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Detergent Options for the Miele G7781 Dental Thermal Disinfector (Originally published in May 2002)

Question: I'm confused about what detergents and rinses need to be used with the Miele InstrumentWasher. Can you explain it, and are there alternatives to using the Miele company's detergents?

Answer: Many Air Force dental clinics use the Miele G7781 thermal disinfector for cleaning anddisinfecting contaminated instruments prior to sterilization. Deciding on the type of detergent and how touse it with the unit can be confusing. This article will explain the use of Miele brand detergents as well asa third-party option. Depending on what detergent is used, the Miele may use up to three chemicals per wash cycle: the detergent, a neutralizing rinse, and a final rinse aid.

Wash Cycle Summary1. Detergent: Either an alkaline or a neutral detergent can be used. Alkaline detergents are reported to be more efficacious thanneutral detergents for removing protein, fats, and oils, but alkaline detergents can damage anodized aluminuminstruments and cassettes. Previous testing by DIS (see DIS 47-39) showed that Getinge/Castle's Neutrawashdetergent (pH 7) cleaned as well as Miele's alkaline wash (pH 11.4 - 11.9) and acid rinse combination, and the costwas considerably less.

Detergents are available in either powder or liquid form.

Powder detergent option With this type of detergent, the powder is placed inside the unit each time a cycle is run.It is placed into a dispensing unit with a lid, which is located inside the Miele washer. This is similar to adding powder detergent to a home dishwasher.

Liquid detergent option Use of liquid detergents avoids the extra step of adding powder to each cycle because theliquid detergent is dispensed automatically by the Miele. Use of a liquid detergent requires purchasing an accessory,

the DOS Module C60 (approximately $550). This is a small "control box" that regulates the automatic dispensing of liquid detergent into the washer. The DOS Module and detergent container sit outside of the washer. An optionalcabinet (Miele model G7796, $1500) is available for storing them. It matches the Miele washer and can be placedimmediately beside it. One storage cabinet can hold DOS Modules and detergent containers for two Miele washers.

2. Neutralizing Rinse: If the detergent used is strongly alkaline, it must be followed by an acidic neutralizing rinse to neutralize the alkalinity.This acid neutralizer is always a liquid. The container for the neutralizer resides outside of the washer, and tubingruns between the washer and the detergent container. An automatic dispensing pump for the neutralizing rinse isincorporated into the washer as standard equipment. The container for the liquid neutralizing agent can be placedinside the optional G7796 storage cabinet mentioned above.





3. Final Rinse: A "rinse aid" solution may be added in the final rinse cycle. This solution is automatically dispensed from a container located in the door of the washer. The rinse aid helps break down surface tension for faster drying and helpsminimize residual spots and films.

CHOICESWash cycle comparisons and product comparisons are shown in the tables below. Note that the most economicaldetergent solution may be to use Castle's Neutrawash. If inadequate cleaning of protein debris is a problem,switching to Castle's Tec Wash III may help.

Company contact information:Miele Appliances, Inc.9 Independence WayPrinceton, NJ 08540(800) 843-7231(609) 419-9898(609) 419-4298 FAXwww.miele.com e-mail: [email protected]

Getinge/Castle,Inc.1777 E. Henrietta RoadRochester, NY 14623-3133(800) 394-4638(716) 475-1400(716) 272-5033 FAXwww.getingecastle.com e-mail: [email protected]

Government facilities, contact Getinge/Castle at:

P.O. Box 9766 Arnold, MD 21012(716) 475-1400(716) 272-5033 FAXe-mail: [email protected]

Comparisons of Wash CyclesDetergent Neutralizer Final Rinse

Option 1 Miele neodisher FA(liquid, pH 11.4 to 11.9)

Miele neodisher N(liquid, pH 2.1 to 2.4)

Miele neodisher Mielclear

Option 2 Miele neodisher MA(powder, pH 11.2 to 12.0)

Miele neodisher N(liquid, pH 2.1 to 2.4)

Miele neodisher Mielclear

Option 3 Castle Neutrawash(liquid, pH 7)

None None (Neutrawashcontains a rinsing agent)

Option 4 Castle Tec Wash III(liquid, pH 11*) None Castle Tec Rinse

Option 5 Castle Tec Wash Powder (powder, pH 11*)

None Castle Tec Rinse

Option 6 Castle Alkaline Detergent(liquid, pH 13)

Castle Acid Detergent(acidic liquid, pH 2.6)

None

*Note: Castle claims that Tec Wash III liquid and Tech Wash powder, while somewhat alkaline, will notharm aluminum and do not require the use of a neutralizing acid rinse.

Product ComparisonsProduct Liquid or

PowderpH at UseDilution

Quantity CompanyPart Number

Govt cost Govt cost(per fl oz)

Miele neodisher FA liquid 11.4 - 11.9 5 ltr 2141679 $75 44¢

Miele neodisher MA powder 11.2 - 12.0 10 kg 2141687 $125 35¢ (oz)

Miele neodisher N liquid 2.1 - 2.4 5 ltr 2141703 $75 44¢

Miele neodisherMielclear

liquid 3.2 - 3.8 1 ltr 2141695 $30 89¢

Castle Neutrawash liquid 7 1 gal5 gal15 gal

613016000096130160001061301600011

$9$43$124

7¢7¢6¢

http://miele.com/

http://www.getingecastle.com/

http://miele.com/

http://www.getingecastle.com/





Castle Tec Wash III liquid 11 1 gal5 gal15 gal30 gal55 gal

6130166830961301667776613016677776130160084461301600845

$12$57$161$321$569

9¢9¢8¢8¢8¢

Castle Tec Wash

Powder

powder 11 25 lb 61301647025 $30 8¢ (oz)

Castle AlkalineDetergent

liquid 13 1 gal5 gal15 gal30 gal55 gal

6130160253961301600040613016000416130160222861301601081

$12$54$151$294$504

9¢8¢8¢8¢7¢

Castle AcidDetergent

liquid 2.6 1 gal5 gal15 gal30 gal55 gal

6130160254061301600042613016000436130160222961301601082

$14$65$189$380$656

11¢10¢10¢10¢9¢

Castle Tec Rinse liquid 3.4 1 gal5 gal15 gal30 gal55 gal

6130160084261301664156613016641576130160129961301603797

$19$86$248$486$967

15¢13¢13¢13¢14¢

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desinfection faq

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